Contract Details
Kelly's Medical Equipment & Supply
Facility name
Kelly's Medical Equipment & Supply
Provider ID
P000005321
NPI
1780609487
Tax ID
421482237
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
4517 Avenue of The Cities
Moline, IL 61265
United States
County
Rock Island
Phone
3097621011 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address